Bibliographic information
GuidelineGuidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters: part 2: central venous catheters
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
WHO suggests using an alcohol chlorhexidine antiseptic (1% or 2%) over other antiseptics (alcohol-iodine or alcohol alone or aqueous formulations) for skin disinfection before central venous catheter (CVC) insertion in adults, adolescents and children. (Short- and long-term catheters) (All population)
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
- It was not possible to decide the precise chlorhexidine concentration to be used (with most studies using 0.5%, 1% or 2%), but the GDG preference (based on their expert opinion) is to use concentrations of chlorhexidine of at least 1%.
- The GDG also discussed that when inserting a CVC, a higher concentration of chlorhexidine might be necessary due to the prolonged presence of the device inside the body. However, it was noted that this may not be required for skin disinfection at other sites where a needle is inserted for only a short period.
- The recommendation applies to adults, adolescents and children, but not neonates (due to the risk of chemical burns with chlorhexidine) (32).
- In the case of availability issues with alcohol-chlorhexidine, other alcohol-based antiseptics (that is, alcohol-iodine) provide an alternative option.
- Consider local availability, context and the cost of suitable alternative skin disinfection preparations.
- Although some studies have referenced the use of 0.5% chlorhexidine, the GDG expresses a preference for concentrations of at least 1%. It is also acknowledged that alcohol–chlorhexidine preparations commonly used for skin disinfection prior to line insertion typically contain 2% chlorhexidine.
- Patients and/or families should be asked about previous chlorhexidine allergy before use.
- All skin antiseptics should be allowed to dry for at least 30 seconds for a maximal effect.